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APPLICATION FOR SANITATION PERMIT Permit No. ___.... (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for to it to construct and install the work herein described. This application is madb tin compliance with County Ordinanc -Y9 , `w. JOB ADDRESS AND LOCATION______ -- ------ -- - --- Owner's Name------ ��. �.. " 11. � Address------------------- --------- I -•- Contractor's Name- Apartment House Commercial ❑ Trailer Court ❑ Motehone___________________________________ Installation will server Residence []- p ❑ ❑ Other ❑ -` , -----------------•-------- Number of living units: _--___._ NuMber of bedrooms__„-__Number'of-baths __/- Lot size ------- Private ______ Water Supply: Public system ❑ Com unity system Private ❑ Depth to Water Table _-______ ft. Character of soil to al.depth of 3 feet: and ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ i Previous Application Made: Yes ❑ No New Construction: Yes 0, No ❑ FHA/VA: Yes ❑ No [� : TYPE OF INSTALLATION AND SPECII^I New i (No septic tank or cesspool permittedwiavailableithin 200 f if-public seer s within o ••.- t Septi Tank: Distance from nearest well________________Distance from foundation__1 ___-_____.Material___--------------------------- Capacity __._'--______�_______: ..___.._.________. No. of compartments___-__, ------__._...__Size--- __ ` Liquid depth f� ; Capacity----- f' ` Dispo al Field: Distance from nearest weli_ -Distancefrom foundation---f4--_____Distance to nearest-lot line s• i _Len th of each line Number of lines----------------- g D pi - - -,---Width of trench----- -----------------_-- T,ype of filter material � �- epth oAfirlter material--4- _ _.____Total length,'-------- ---------------- Seepage Pit: Distance to nearest will--------------- from foundation__-_.___.Distance to nearest lot line----------------- i t - ❑ Number of pits_..._----___�_-_- _--Lining', material---------- _.Size: Diameter_______________ Depth-- ------ ---------------------- ___ __ � r 1Distance from nearest Jwell________----� -Distance from foundation_,______. _-- Lining materal_._'------------------------------------ Cesspool- 0 ______________________-___: ____ Cesspool: ❑ Sze: Diameter.-- -Depth --- -- - -- . - Li uid Ca ecitY gals. -------- € t ij Privy: Distance from nearest'Tweli________ _ ______________________ ------ from nearest building__.___________---_____________.___--.._. (� Oistance to nearest lot line-------------E-------------------------------------------------------( ----------------------------� 11 M ------ ---------------------------r ----------------. - Remodeling and/or repairing (describe):---------- 1.--•------- --------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------4 ---------------------------------_-------------------------------------------------------------_-------------_____-------------------------------------------------------- --------- _____ ____----- __ __ ___ __ _ _ __ _ _______________________________________________________________________________________________________________________________________________________________________________________ l hereby certif__y___tha+ I have prepared this applica+ion and tha+ the work will be done in accordance 'with San Joaquin County } ordinances, State ,laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Thr y - -------------------------------------------------(Owner and/or Contractor) By: -------•-------------- ------------ ------------------------------ ------------------------- (Title)-------------------- ------ --- ---- ----------- ------------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY ---------------------------- f r ; APPLICATION ACCEPTED BY-------------------------- - --- DATE------ --------- ---- ------ 3 REVIEWED BY —I-------:----� `" =_,.,'".'. ",- =.� , =- — .= ::� r �.�= ,DATE- _ �7 i------------ ------------------------------ �_ - � BUILDINGPERMIf ISSUED----------------------------------------- ----- ----------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------- -----------------------•------•-------------------------_------...--------------_------------------•-------------- -------------- -------------------------------------- -----•----------------------•-----------•------------------------------- ---- --------------------•----------------------------------- ------ - -•------------------------------- FINAL INSPECTION BY:. ----- _ �------------ ---------------- Date-------- ---A- -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street a 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California C' i ES-9=2M Revised 8-'59 F.P,Co.